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Supplemental Cardioplegia During Donor Heart Implantation: A Systematic Review and Meta-Analysis
Roberto V P Ribeiro1, Jan O Friedrich2, Maral Ouzounian3
1Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
Insights
Supplemental cardioplegia improves early survival and reduces complications in heart transplantation. This strategy may enhance outcomes, particularly with marginal donor organs.
Area of Science:
- Cardiology
- Transplantation Surgery
- Critical Care Medicine
Background:
- Optimal donor heart preservation during transplantation is debated.
- This study analyzes supplemental cardioplegia's impact on donor heart management.
Purpose of the Study:
- To systematically review and meta-analyze the effect of supplemental cardioplegia during donor heart implantation.
- To assess its influence on early morbidity and mortality in heart transplant recipients.
Main Methods:
- Systematic review and meta-analysis of studies comparing supplemental cardioplegia versus no supplemental cardioplegia.
- Searched MEDLINE and Embase databases up to February 2019.
- Included 7 retrospective observational studies and 3 randomized controlled trials (1125 patients).
Main Results:
- Supplemental cardioplegia improved early survival (RR 0.55) and spontaneous sinus rhythm (RR 2.62).
- It reduced intensive care unit stay by 3.4 days and decreased ischemic changes on biopsy (RR 0.49).
- Midterm mortality showed no significant difference between groups.
Conclusions:
- Supplemental cardioplegia may reduce organ ischemic injury and improve early heart transplant survival.
- This cost-effective strategy could enhance outcomes, especially with marginal donor organs.
- Further research is needed to confirm these findings.
Background:
The optimal donor heart preservation and management strategy during heart transplantation remains controversial. We report the results of a systematic review and meta-analysis of the effect of supplemental cardioplegia administration during donor heart implant for transplantation.
Methods:
We searched MEDLINE and Embase databases until February 2019 for studies comparing patients who received transplants with the donor heart given supplemental cardioplegia or not. Data were extracted by 2 independent investigators. The main outcomes were early morbidity and mortality.
Results:
Included were 7 retrospective observational studies (4 comparing to historical controls) and 3 randomized controlled trials enrolling 1125 patients. Supplemental cardioplegia included crystalloid and blood cardioplegia given continuous retrograde or as terminal "hot shots." Supplemental cardioplegia was associated with improved early mortality (risk ratio [RR], 0.55; 95% confidence interval [CI], 0.35-0.87; P < .01), greater rates of spontaneous return of sinus rhythm (RR, 2.62; 95% CI, 1.50-4.56; P < .01), shorter intensive care stay (mean difference, -3.4 days; 95% CI, -5.1 to -1.6; P < .01), and lower incidence of ischemic changes seen on endomyocardial biopsy specimens (RR, 0.49; 95% CI, 0.35-0.69; P < .01) compared with controls. Midterm mortality was not different between groups (incident rate ratio, 0.80; 95% CI, 0.51-1.26; P = .34).
Conclusions:
Administration of supplemental cardioplegia may be associated with a reduction in organ ischemic injury and shorter intensive care stay as well as improvement in early survival after transplantation. This strategy may be a simple and cost-effective adjunct to improve outcomes of heart transplantation, especially in an era of increasing use of marginal donor organs. Further investigation will be needed to confirm the findings of this hypothesis-generating study.
